Internationally Qualified Nurse Checklist

Please send this completed form along with the documents listed under Section A of the checklist below.
You should now also start to request documents from Section B from the relevant organisations.

Additional forms & guides you may require can be found at:
http://www.nursingcouncil.org.nz/Nurses/International-registration

Office Use Only Box

First Name:
Reference #:
Middle Name(s):
Payment Received:
Surname/Family Name:
Date
Date of Birth: Received:

Section A Section B
All of these documents to be sent together in (see our guide to these on the link provided above)
one courier pack/envelope
(see our guide to these on the link provided above) • Verification of your registration
• Checklist & signed declaration • Transcript(s) of training
• Certified copy of passport
• Certified copy of registration certificate Please note that you will be advised when you
• Certified copy or original IELTS/OET test are required to complete an International Criminal
results History Check as per Council guidelines.
• Detailed curriculum vitae
• Two (2) original, signed and dated
professional references
• One (1) original, signed and dated
character reference
• Employment letter
• Certified copy of marriage certificate (if
applicable)

Declaration
I, ……………………………………….. do solemnly and sincerely declare that all the details and information provided
in respect of my application for registration with the Nursing Council of New Zealand are true and correct.
I understand that under the Health Practitioners Competence Assurance Act 2003 (“The Act”), if the information
submitted to obtain registration is found to be false or misleading
• my application may be declined under sections 16(h) and 20 of the Act, or
• any registration obtained may be cancelled under section 146 (1) (a) or(b) of the Act.
In addition, every person who makes a declaration or representation or provides any document knowing it
contains any false or misleading declaration, or provides a document knowing that it is not genuine commits an
offence and is liable on summary conviction to a fine not exceeding $10,000 under section 172 of the Act.

Signature: Date:
Delivery Address:
Nursing Council of New Zealand, Level 5, 22 Willeston Street,
Wellington 6011, New Zealand

Please note that the Nursing Council of New Zealand encourages the use of couriers or registered post for the
delivery of documents. Any request for documents to be returned will be at cost to the applicant.